Dysphagia Symptoms in ALS

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Answer

In patients with ALS, dysphagia symptoms are going to vary. It depends upon the type of ALS the patient has.  If the patient has the bulbar form of the disease, dysphagia may be one of the first symptoms. There are times when the SLP may be among the first providers that sees these patients, and it may be prior to a definitive diagnosis being made.  Sometimes primary care physicians will refer for a swallow evaluation or for a speech evaluation; in the case of swallowing, because the individual presents with dysphagia symptoms in the absence of any other diseases.  I have had patients come in that have had CT scans or MRIs, and stroke and head injury have been ruled out.  The physician is trying to figure out the etiology for the symptoms that the patient is reporting.  In those cases, the SLP needs to take a thorough case history. The SLP also needs to complete a thorough oral mechanism exam and make sure any significant findings are reported, and then do a complete swallow evaluation.  These results can assist the primary care physician in making referrals to other healthcare providers.  It is certainly appropriate for the SLP to suggest that the individual be referred to neurology for further workup.

Debra M. Suiter is Director of the Voice & Swallow Clinic at The University of Kentucky in Lexington, Kentucky. She is a Board Certified Specialist in Swallowing. She is the Chair of the ASHA Board of Special Interest Group Coordinators and currently serves on the American Board for Swallowing and Swallowing Disorders and the board of the Dysphagia Research Society. Her research focuses on screening and evaluation methods for individuals at risk for dysphagia.